Counseling Patients on OTC Drugs

NOVEMBER 01, 2004

Stefanie Ferreri, PharmD, CDE

The involvement of pharmacists
in nonprescription medication
counseling will increase the public's
ability to understand the risks and
benefits of OTC remedies. It has been
well documented that interactions by
pharmacists through consultation and
effective assessment strategies can
enhance patient outcomes. In order to
counsel patients efficiently, pharmacists
must be able to communicate.

One way to ensure understanding is
through active listening, a process in
which the receiver repeats the information
back to the sender. This process
fosters information exchange and promotes
effective learning. The first step
in achieving optimal communication
is setting the stage. By identifying
potential barriers in the pharmacy that
can impede good communication,
pharmacists can actively take steps to
overcome them. It is important to
remove distractions or barriers that
may affect interactions with patients.

Potential Barriers to Patient
Consultation

Several barriers exist in a community
pharmacy environment. The 3 most
common are barriers from the pharmacy
environment, barriers arising from
the pharmacist, and barriers stemming
from the patient.

Pharmacy Environment

The design of a pharmacy has a
major impact on how patients view
pharmacists and react to their consultation
efforts. Environmental barriers
present a challenge for all pharmacist?patient interactions. For example,
the presence of a high counter prevents
easy eye contact and makes a
pharmacist seem aloof and even uncaring.
The lack of semiprivate space
deters patients from asking questions
of their pharmacist or describing problems.

To overcome these types of environmental
and physical barriers, the pharmacist
should come out from behind
the dispensing area to consult with
patients and communicate face to face.
By sitting or standing at eye level or
lower, the pharmacist does not seem
threatening, and that stance opens
lines of communication.1 If it is not
possible for the pharmacist to come
out from behind the counter, he or she
should attempt to minimize the barrier
produced by the counter by focusing
on the patient.

Pharmacist Barriers

Other barriers also can impede pharmacist?patient communication. Such
barriers include inappropriate use of
interpersonal space by the pharmacist,
inappropriate body language, or inappropriate
vocal characteristics. Corrective
actions for these kinds of barriers
can be remembered by Muldary's
acronym, "CLOSER" (Table 1).2

Patient Barriers

Patients also can create barriers that
pharmacists must recognize. Functional
barriers hinder the patient's ability
to understand information that is
being communicated by the pharmacist.
Examples of functional barriers are
listed in Table 2.

Sensory deficits include blindness,
deafness, or other visual impairments.
Whereas some barriers are easily recognized
through common sense, environmental
barriers that are of relevance
only to some individuals may
not be obvious. For example, patients
with poor vision may have difficulty
reading OTC labels. During patient
consultation, the pharmacist should
assess how the pharmacy environment
affects communication with the
patient and take steps to minimize any
barriers when possible.

In addition, language differences can
be a frustrating barrier when counseling
a patient about an OTC agent. Typically,
children will accompany an
older member of the family, and they
can be used to help translate. In addition,
bilingual police officers may be
available in some areas to help. Providing
written sheets along with verbal
communication may help facilitate
communication. Also, using pictures
may be beneficial.

Functional illiteracy and low health
literacy affect counseling about nonprescription
agents. Patients who are
functionally illiterate are difficult to
identify because they often try to hide
their inability to read or write. Patients
with low health literacy have difficulty
understanding disease-related information,
medication information, and
directions. These types of problems can
lead to medication errors and worsen
patient outcomes.

Comprehension difficulties can arise
from dementia, psychiatric conditions,
or mental retardation. Whatever the
cause, the patient's inability to understand
medication instructions may be
difficult to overcome. Having a caregiver
present can help with communication.

A patient's alternative health beliefs
and personal health beliefs also can be
functional barriers. Patients who have
a different set of beliefs from Western
medicine can be difficult to identify.
Some signals that may alert pharmacists
to this barrier include poor adherence
and persistent questioning about
an effect of a medicine.

Several books have been written
about cultural differences in health
care. This subject requires sensitivity
on the part of the pharmacist. If possible,
pharmacists should educate themselves
about the beliefs of the people in
the cultures they serve. This information
can be used to avoid negative
interactions and help support the communication
pharmacists will have with
patients.

Overcoming Barriers

In addition to Muldary's acronym,
other techniques can be utilized to
facilitate understanding and open lines
of communication between pharmacists
and patients.

Pharmacists should keep the following
tips in mind:

Be an active listener

Use clear, unambiguous language appropriate to the knowledge of the patient

Be cognizant of nonverbal cues

Ask for feedback so as to clarify any misunderstandings

Provide feedback, outlining the message

Some common barriers to active listening
are multitasking, selectively listening
to the patient, having internal
monologue or planning one's next
point while the patient is speaking,
leaping ahead to make a conclusion,
listening with one's ears only, or being
too quick to jump in. Pharmacists need
to recognize these obstacles to nonprescription
counseling and take steps to
overcome them.

Pharmacists are the nonprescription
medication experts. Patients recognize
this fact and typically use pharmacists
as first-line sources of drug information.
In order for pharmacists to nurture
the relationships they have with
patients, they must set the stage for
optimal communication by using
active listening, minimizing environmental
barriers, eliminating pharmacist
barriers, and overcoming patient
barriers that may make counseling
more difficult.

Dr. Ferreri is a clinical assistant professor at
the University of South Carolina School of
Pharmacy.